Provider Demographics
NPI:1174037279
Name:LIVERMORE, TRISHA (PT)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:LIVERMORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 PLAZA RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-2975
Mailing Address - Country:US
Mailing Address - Phone:845-339-4722
Mailing Address - Fax:845-339-5730
Practice Address - Street 1:340 PLAZA RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-2975
Practice Address - Country:US
Practice Address - Phone:845-339-4722
Practice Address - Fax:845-339-5730
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042413-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14-1706861OtherTAX ID